Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Research Article Volume 6 Issue 10

Laparoscopic Transanastomotic Dilatation of Stennosed Biliodigestive. Description of the Approach Technique

Al Awad Jibara A1, Ramirez A2 and Valera Garcia VG3*

1General Surgeon, HepatoBiliary and Pancreatic Surgeon, Doctor of Medical Sciences. Retired Professor of Human Anatomy, Universidad del Zulia – Maracaibo, Edo, Zulia, Venezuela
2General Surgeon, HepatoBiliary and Pancreatic Surgeon, Assistant Professor of Surgery, Universidad de Los Andes, Mérida, Edo. Merida, Venezuela
3General Surgeon, Fellow HepatoBiliary and Pancreatic Surgery, University of Zulia, General Hospital of Cabimas, Cabimas, Edo. Zulia, Venezuela

*Corresponding Author: Valera Garcia VG, General Surgeon, Fellow Hepato Biliary and Pancreatic Surgery, University of Zulia, General Hospital of Cabimas, Cabimas, Edo. Zulia, Venezuela.

Received: July 31, 2023; Published: September 06, 2023


Biliodigestive bypass is the surgical establishment of a bypass between some portion of the biliary tree and the digestive tract and has played an integral role in the surgical management of biliary tract disease. Stenosis of the hepatojejunal biliary-enteric anastomosis, defined as the reduction in the caliber of the anastomosis that leads to partial or total obstruction and consequently biliary retention, represents more than 50% of these complications. Stenosis recurrence is reported in 10% of patients and is a serious complication that can lead to recurrent episodes of cholangitis, biliary cirrhosis, liver failure, and death. When it is not possible to perform the endoscopic or percutaneous approach, or they have failed, surgical management of the stenosis is considered, for which we describe the use of the transanastomotic laparoscopic dilation technique of biliodigestive stricture, which consists in disarming the 50% of the anastomosis and dilate it under direct vision using a Maryland dissector controlled and selectively either to the common duct or to both ducts separately. Also through this approach it allows us to accurately visualize if the stenosis is from the duct bile duct or jejunal loop and the presence of biliary sludge or stones inside the bile duct. This approach offers the advantages of minimally invasive surgery while reducing the injury and devascularization to the perihilar biliary tissue that occurs during a reconfection.

Keywords: Anastomosis; Stricture; Biliodigestive; Hepaticojejunostomy; Laparoscopy


  1. Díaz Benítez MI and Mendoza Galván ED. “Prevalence of biliodigestive diversion in patients diagnosed with choledocholithiasis in a highly complex hospital. Period 2014-2018”. Parag 44.2 (2010).
  2. Ahrendt SA and Pitt HA. “A History of the Bilioenteric Anastomosis”. Archives of Surgery11 (1990): 1493.
  3. Kadaba RS., et al. “Complications of biliary-enteric anastomoses”. Annals of The Royal College of Surgeons of England 99 (2017): 210-215.v
  4. Pérez PY., et al. “Endoscopic cholangiography assisted by laparoscopic enterotomy”. Endoscopic Surgery3-4 (2017): 119-124
  5. Lee AY., et al. “Percutaneous Transhepatic Balloon Dilation of Biliary-Enteric Anastomotic Strictures after Surgical Repair of Iatrogenic Bile Duct Injuries”. PLoS ONE10 (2012): e46478.
  6. Cauchy F and Belghiti J. “Hepaticojejunostomy Anastomotic Strictures”. Gastrointestinal Surgery (2015): 239-248.
  7. Lorenz JM., et al. “Balloon Dilatation of Biliary–Enteric Strictures in Children”. American Journal of Roentgenology 184 (2005): 151-155.
  8. Vargas-Ávila AL., et al. “Perpendicular duodenum-jejunum anastomosis”. Surgery and Surgeons 5 (2021).
  9. Al Awad ., et al. “Endoscopic transjejunal dilation of benign biliary stenosis”. REVISTA VENEZOLANA DE CIRUGÍA 54 (2001): 146-152.
  10. Cevallos Alvarado MA., et al. “Risk factors in laparoscopic surgery”. RECIMUNDO 5.2 (2021): 230-237.
  11. Antolovic D., et al. “Hepaticojejunostomy–analysis of risk factors for postoperative bile leaks and surgical complications”. Journal of Gastrointestinal Surgery 11 (2007): 555-561.
  12. Sewnath ME., et al. “A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice”. Annals of Surgery 236 (2002): 17-27.
  13. Hammad H., et al. “Treating Biliary-Enteric Anastomotic Strictures with Enteroscopy-ERCP Requires Fewer Procedures than Percutaneous Transhepatic Biliary Drains”. Digestive Diseases and Sciences 64 (2019): 2638-2644.
  14. García-Cano Lizcano J., et al. “Complications of endoscopic retrograde cholangiopancreatography: Study in a small ERCP unit”. Revista Espanola De Enfermedades Digestivas 3 (2004): 163-173.
  15. Saad WE., et al. “Quality improvement guidelines for percutaneous transhepatic cholangiography, biliary drainage, and percutaneous cholecystostomy”. Journal of Vascular and Interventional Radiology 21 (2010): 789-795.
  16. Mukund A., et al. “Percutaneous Management of Resistant Biliary-Enteric Anastomotic Strictures with the Use of a Combined Cutting and Conventional Balloon Cholangioplasty Protocol: A Single-Center Experience”. Journal of Vascular and Interventional Radiology 26 (2015): 560-565.


Citation: Al Awad., et al. “Laparoscopic Transanastomotic Dilatation of Stennosed Biliodigestive. Description of the Approach Technique".Acta Scientific Gastrointestinal Disorders 6.10 (2023): 22-28.


Copyright: © 2023 Valera Garcia VG., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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